Abstract
Surgery patients with COPD have more episodes of post op bronchitis, pneumonia and longer length of stays (Manganas H 2007). NHANES data shows that less than 50% of patients with COPD are recognized. It is assumed that unrecognized COPD is less severe and therefore does not significantly affect perioperative morbidity.
We aimed to determine the prevalence and effect of undiagnosed COPD on perioperative morbidity measured by hospital length of stay (LOS), in a population selected for COPD risk.
Spirometry was performed in an at risk population (≥ 40 y.o. with a smoking history ≥ 20 pack-years) scheduled for elective surgery, during preoperative assessment (Ohar J 2011). Obstruction was defined by an FEV1/FVC < 70%.
Of the 199 subjects tested, 79 (40%) met spirometric criteria for obstruction. Only 9 of the 79 (11%) were previously recognized. Subjects with previously recognized COPD were older (75±8 v. 66±10 y.o.; p<0.05), smoked more (90±51 v. 49±20 pack-years; p<0.0001) and had more severe obstruction (50±26 v. 69±17% predicted; p<0.01) than did those with previously unrecognized COPD, respectively. Despite the significant differences in previously recognized and unrecognized COPD, there was no difference between the two in LOS (1.8±2.3 v. 1.9±3.1days; p=0.09). LOS adjusted for procedure (actual/expected LOS) was also not significantly different (0.69±0.43 and 0.99±1.14 for recognized and unrecognized COPD, respectively; p=0.45).
Conclusion: The prevalence of unrecognized COPD among surgical patients is quite high and it appears to affect perioperative morbidity similarly to previously recognized COPD. The data suggests that spirometric testing of an at risk population for COPD may have value in preoperative assessment.
- © 2012 ERS
